Microsurgical resection of petroclival meningiomas by subtemporal transpetrosal-transtentorial approach assisted with neuroendoscopy

Abstract

Objective To study the removal technique and operative experiences in the microsurgical resection of petroclival meningiomas with the subtemporal transpetrosal-transtentorial approach assisted with neuroendoscopy,and to improve the rate of total resection of tumors and the postoperative results.Methods Consecutive 21 cases of petroclival meningiomas treated from Jan.2002 to Jun.2012 by microsurgical technique using the subtemporal transpetrosal-transtentorial approach were reviewed retrospectively.Among the 21 cases,11 patients were operated with an assistance of neuroendoscopy.The tumor control rate,postoperative neurological deficit,and functional status were assessed by the Karnofsky Performance Score (KPS),and to evaluate the indications,advantages and disadvantages of this approach in assistance with neuroendoscopy.Results Gross total tumor resection was achieved in 10 patients,subtotal resection in 8 cases,and partial resection in 3 cases.New developed cranial nerves dysfunction and deterioration of original symptom after the operation were found in 7 patients.There were no deaths and longterm coma.The surgical results of patients assisted with neuroendoscopy were better than only using microscope,P ＜ 0.05.Conclusions The subtemporal transpetrosal-transtentorial approach in assistance with neuroendoscopy is suitable for petroclival meningiomas mainly in the middle fossa with extension to the posterior fossa (type Ⅰ).By resecting the petroal bone,this approach can improve the rate of total resection of tumors and the postoperative results,while decreasing the postoperative functional deficit of the cranial nerves. Key words: Petroclival meningioma ; Neuroendoscopy; Microsurgery ; Subtemporal transpetrosal-transtentorial approach